Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, Scopus, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5,559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odds ratio 0.69, 95% CI 0.56 to 84, p-value for overall effect 0.002. The DASH diet was better than Mediterranean Diet (odds ratio, 0.71, 95% CI 68 to 74, p-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odds ratio, 0.77, 95% CI 0.55 to 1.06, p-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odds ratio 0.65, 95% CI 0.53 to 80, p < 0.0001) and started in the first trimester (odds ratio, 0.57, 95% CI 0.43 to 0.75, p < 0.0001. No significant effect was found when the exercise was vigorous (odds ratio 1.09, 95% CI 0.50 to 2.38, p = 0.83) and started during the second trimester of pregnancy (odds ratio, 1.08, 95% CI 0.65 to 1.80, p = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.

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